Differentiation of acanthamoeba keratitis from other non-acanthamoeba keratitis: Risk factors and clinical features.

INTRODUCTION: Infectious Keratitis is one of the most common ocular emergencies seen by ophthalmologists. Our aim is to identify the risk factors and clinical features of Acanthamoeba Keratitis (AK). METHODS: This retrospective chart review study was conducted at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, and included all the microbial keratitis cases, male and female patients of all ages. The main outcome is the differentiation between various microbial keratitis types. RESULTS: We included 134 consecutive eyes of 126 persons. We had 24 cases of acanthamoeba keratitis, 22 bacterial keratitis, 24 fungal keratitis, 32 herpetic keratitis, and 32 bacterial co-infection. Contact lens wear was found in 33 eyes (24.6%). Among acanthamoeba keratitis patients, 73% were ≤ 39 years of age, and 73% were females (P <0.001). Also, in AK cases, epithelial defect was found in all cases (100%), endothelial plaques were found in 18 eyes (69.2%), 12 cases had radial keratoneuritis (46.2%), and ring infiltrate was found in 53.8% of AK cases. CONCLUSIONS: We determined the factors that increase the risk of acanthamoeba infection and the clinical characteristics that help distinguish it from other types of microbial keratitis. Our findings suggest that younger females and patients who wear contact lenses are more likely to develop acanthamoeba keratitis. The occurrence of epitheliopathy, ring infiltrate, radial keratoneuritis, and endothelial plaques indicate the possibility of acanthamoeba infection. Promoting education on wearing contact lenses is essential to reduce the risk of acanthamoeba infection, as it is the most significant risk factor for this infection.

Visual outcomes and recurrence rate of macular corneal dystrophy following phototherapeutic keratectomy in Saudi Arabia.

PURPOSE: The purpose of the study was to evaluate the visual outcomes and recurrence rate of patients with macular corneal dystrophy (MCD) who have undergone phototherapeutic keratectomy (PTK). METHODS: This retrospective, single-centered study enrolled patients from King Khaled Eye Specialist Hospital who had undergone PTK for MCD between 2000 and 2020. Pre-, intra-, and post-operative data were collected, and the primary outcome measures included uncorrected visual acuity, best-corrected visual acuity (BCVA), spherical equivalent, central keratometry, keratometric astigmatism, recurrence rate, and necessity of subsequent surgery. RESULTS: This study evaluated 42 eyes of 29 patients. BCVA improved from 0.41 (±0.17) preoperatively to 0.30 (±0.16) postoperatively. Sixteen out of 42 eyes (38%) had the recurrence of macular dystrophy deposits within the stroma; the average time from PTK to recurrence was 37 months (range: 5.5-115.4 months). The overall success rate of PTK at 2 years was 44.8%. Eleven eyes (26%) required subsequent surgery following PTK at an average of 43 months postoperatively. Deeper ablation and longer application of mitomycin C (MMC) were both found to be statistically significant factors associated with visual improvement and lower recurrence rate following PTK. CONCLUSION: PTK can be considered a treatment modality for younger patients to defer keratoplasty to a later stage. Deeper ablation is associated with improved postoperative visual acuity, and longer application of MMC is associated with lower recurrence rates of MCD.

The Association of Screen Time, Sleep Quality, and Dry Eye Among College Students in Saudi Arabia.

Background Dry eye is a serious public health issue that causes ocular discomfort, weariness, and visual disturbances that can disrupt everyday activities. Dry eye disease is one of the most common reasons people seek eye care. Therefore, this study aimed to assess the association between screen time, sleep quality, and dry eye among college students in Saudi Arabia. Methods This cross-sectional study was conducted among college students in Saudi Arabia. Data were collected through a validated questionnaire distributed via social media. Results A total of 1,593 participants were included. Many of them were aged between 18-25 years (80.7%) and females were (65.0%). Females and residents of the middle region had significantly more severe sleep-wake difficulties than other people (p<0.001). Participants with a master's degree had lower severe sleep-wake difficulties than other participants (p<0.001). Participants who spent between 4-6 hours on the screen showed high severe sleep-wake difficulties (p<0.001). Regarding eye dryness, females, participants with a bachelor's degree, and participants who spent more than six hours on screen had more severe symptoms of eye dryness. Nearly half of the participants with severe sleep-wake difficulties reported mild to moderate symptoms of dry eye (p<0.001). Conclusions Our study concluded that university students in Saudi Arabia had significant sleep-cycle difficulties and mild to moderate eye dryness symptoms. Age, female gender, sleep duration, educational level, monthly income, and excessive screen time were found to be associated with sleep-cycle problems and eye dryness symptoms.

Microbial Keratitis following Self-Retained Cryopreserved Amniotic Membrane.

The aim of this study was to report a severe case of mixed fungal and bacterial microbial keratitis following implantation of a self-retained cryopreserved amniotic membrane, PROKERA® SLIM (Bio-Tissue, Inc) in a patient with history of neurotrophic ulcer secondary to herpetic epithelial keratitis. Despite maximally tolerated topical and systemic therapy, the patient's eye continued to deteriorate and eventually required evisceration. PROKERA implantation might be associated with severe recalcitrant microbial keratitis. Caution is urged when considering implantation especially in monocular patients.

Ophthalmic Features of Spinocerebellar Ataxia Type 7: A Case Report.

BACKGROUND Spinocerebellar ataxia (SCA) is an inherited progressive neurodegenerative disorder characterized by late-onset cerebellar and brainstem dysfunction. It is an autosomal dominant condition with monoallelic pathogenic expansion in the ATXN7 gene. Patients have neurological deficits, including ataxia and dysarthria. Visual symptoms are the first presenting signs in patients with SCA type 7 (SCA7), including severely affected visual acuity and color vision, ocular motility impairment, and retinal macular degeneration. This is one of the first reports of the existence of keratoconus in a patient with SCA7. Few theories explain this coexistence, including vigorous rubbing of the eyes, and genetic and environmental etiologies. CASE REPORT A 34-year-old man with SCA7 underwent genetic and ophthalmic investigations. Multiple family members of the patient had a positive history of ataxia. He had an abnormal posterior and anterior corneal elevation on Pentacam (Pentacam-Oculus, Optikgeräte GmbH, Wetzlar, Germany) and was eventually diagnosed with keratoconus in both eyes, which is not a known feature of SCA7. Later, he underwent a penetrating keratoplasty in the left eye with no subsequent improvement in vision. No further treatment was offered to the patient due to the guarded visual prognosis caused by the retinal pathology. He continues to have routine follow-ups in the Ophthalmology Clinic. CONCLUSIONS This case reinforces the importance of recognizing the guarded visual outcome in these patients due to the macular degeneration and progressive nature of the disease. Therefore, appropriate and adequate patient counseling about the visual prognosis is essential before proceeding with any ocular surgical interventions.

Genetic profiling of rhabdomyosarcoma with clinicopathological and radiological correlation.

OBJECTIVE: Orbital Rhabdomyosarcoma is a highly malignant tumor predominantly affecting children. Our study adds more understanding of this tumor to ophthalmologists from the clinicopathological, radiological and genetic aspects. DESIGN: A retrospective clinicopathological and radiological study of ocular rhabdomyosarcoma with genetic profiling. PARTICIPANTS: All the cases with confirmed tissue diagnosis of orbital rhabdomyosarcoma presenting at a tertiary eye hospital in Riyadh, Saudi Arabia during the period 1985-2015. METHODS: Charts and histological slides of 26 patients were reviewed. DNA was extracted from paraffin-embedded biopsies and genotyping was performed to detect chromosomal abnormalities and Copy-number variations regions. RESULTS: 18 males and 8 females were included with a mean age at presentation of 6.9 years (SD of 4.4). Proptosis and globe displacement were the commonest clinical presentations. Embryonal histopathological type was the commonest (73.1%) with superior orbital involvement (p = 0.024). Using magnetic resonance imaging, the embryonal type showed higher Apparent diffusion coefficient (ADC) value compared to the alveolar type (p = 0.98). Genetic profiling showed Copy-number gain in regions spanning PAX3, DDIT3, Gli, Wnt6 genes. DICER1 gene implication was found in 9 sporadic cases. CONCLUSION: Rhabdomyosarcoma is rare and occurs with a mean age of 7 years, predominantly among males. The commonest embryonal type is significantly correlated with superior orbital involvement. Radiologically, it shows an ADC of 0.67-0.09 × 10-3mm2/s. (p = 0.98). The gain in PAX3, DDIT3, Gli1, Wnt6 genes is a new finding while the DICER1 gene implication in the absence of familial hereditary carcinoma is another interesting finding.